Primary Tumor Surgery for Patients with De Novo Stage IV Breast Cancer can Decrease Local Symptoms and Improve Quality of Life

Abstract

Background. It was unknown whether surgery for primary tumor would affect the occurrence of local symptoms caused by tumor progression in patients with de novo stage IV breast cancer (BC). Our work attempted to probe the effect of local resection on controlling local symptoms and improving the quality of life in de novo stage IV BC patients. Methods. Our study included patients presenting with de novo stage IV BC at the Cancer Hospital of the Chinese Academy of Medical Sciences from January 2008 to December 2014. In this study, we defined a new term called ''local progress/recurrence of symptoms'' (LPRS) to refer to the local problems caused by tumor progression/ recurrence. All the patients were grouped into surgery and non-surgery groups. The characteristics of the two groups were analyzed by Chi square and Fisher's test. Univariate and multivariate Cox regression models were designed to evaluate independent prognostic factors. Results. This study contained 177 patients. The follow-up deadline was April 1, 2019. The median follow-up time was 33 months (range 1-135 months). In included patients, 77 (43.5%) underwent surgery for primary tumors. Primary tumor surgery could reduce the occurrence of LPRS (relative risk/risk ratio (RR = 0.440; 95% CI 0.227-0.852; p = 0.015)) and patients without LPRS had longer OS (45 months vs 29 months, p \ 0.001). In addition, patients who had only one symptom had better OS than those who had two or three symptoms (p = 0.0175). Conclusions. The quality of life in patients with de novo stage IV breast cancer can be improved by reducing the incidence of local symptoms through primary tumor surgery. Keywords De novo stage IV breast cancer Á Local symptoms Á Primary tumor surgery Á Quality of life Á Survival Abbreviations BC Breast cancer LPRS Progress/recurrence symptoms OS Overall survival LPFS Local progression-free survival AJCC American Joint Committee on Cancer CR Complete response PR Partial response Generally, 3-5% of breast cancer (BC) patients in China are initially diagnosed as de novo stage IV BC. 1 The standard therapeutic approach was systemic therapy, especially chemotherapy. 2 Along with improvement of systemic treatment, which had prominently prolonged survival of patients, the effect of primary tumor surgery on de novo stage IV BC has gradually become a hot topic. 3

Predicting the survival benefit of local surgery in patients aged 70 years or older with stage IV breast cancer: A population-based analysis

“…According to the E2018 trial, although surgery reduced the proportion patients with local regional recurrence or progression in three years, it did not improve health-related quality of life [23]. However, a retrospective analysis from China suggested that the quality of life in patients with de novo stage IV BC can be improved by reducing the incidence of local symptoms through primary tumor surgery [28]. Several cases have reported that LRT could solve local problems, improve the quality of life of patients, and reduce the psychological pressure of advanced BC [29].…”

Gastric Metastasis at the First Presentation of Breast Cancer May Mimic Primary Carcinoma: A Case Report and Literature Review

“…Copyright © Jiayu Wang GMR.000609. 5 (2).2020 that of ductal subtype, to metastasize in stomach with incidence of 69.1%. The luminal subtype was supposed to hold the foremost rate of 92.1% and triple-negative (TN) also had a risk of 7.9%, while gastric metastasis was not documented to occur in HER2 enriched subtype (Table 2).…”

“…Copyright © Jiayu Wang GMR.000609. 5 (2).2020 and CYFRA21-1 9.85ng per milliliter (0.0-3.3). Test for hepatitis B, hepatitis C, syphilis and human immunodeficiency virus were negative.…”

“…Over the recent decades, more than 90% breast cancer at newly diagnosed is early-stage disease due to the development and generalization of screening mammography [1]. De novo stage IV breast cancer is defined as the advanced disease with synchronous involvement of distant metastasis, which accounts for mere 6% proportions in female breast cancer [1,2]. The common metastatic sites from primary breast cancer are bone and lung, whereas the metastasis to gastrointestinal (GI) tract is not frequent.…”

Locoregional Treatment in De Novo Metastatic Breast Cancer: A Retrospective Cohort Study

“…De novo metastatic breast cancer (dnMBC) refers to patients with metastatic breast cancer at initial diagnosis, and has been reported that approximate 10% of newly diagnosed breast cancer patients present with distant metastases [1][2][3] . This group of patients with dnMBC makes up about 3-8% of new breast cancer diagnoses in the USA and Western [1,4] , and 3-5% of these patients in China [5] . Their overall survival (OS) was approximately 16 to 29 months [6] .…”